Atypical Takotsubo Cardiomyopathy Presentation in an Adult Patient

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Takotsubo cardiomyopathy (TSC), or stress-induced cardiomyopathy, is typically characterized by transient left ventricular dysfunction, often mimicking acute coronary syndrome (ACS).
• Classic TSC presentations involve older females experiencing chest pain, with ECG changes and elevated troponins, similar to ACS.
• This condition is usually triggered by significant physical or emotional stress.

Observation:

• A middle-aged African American female presented with a four-day history of vomiting, denying chest pain or recent stressors.
• Her medical history included COPD, hypertension, and HIV on antiretroviral therapy.
• During hospitalization, she developed shortness of breath, elevated troponin levels, and global T wave inversions on ECG.

Findings:

• Cardiac catheterization revealed left ventricular akinesis and an ejection fraction below 30%.
• Crucially, no obstructive coronary artery disease was identified, confirming the diagnosis of Takotsubo cardiomyopathy.
• This presentation deviates from the typical demographic and initial symptomatology of TSC.

Implications:

• This case underscores that Takotsubo cardiomyopathy can manifest with atypical symptoms, such as isolated vomiting, particularly in middle-aged women.
• Physicians should consider TSC in the differential diagnosis for patients presenting with non-cardiac symptoms and ECG/troponin abnormalities, even without typical triggers.
• Recognizing these atypical presentations is vital for timely diagnosis and appropriate management of Takotsubo cardiomyopathy.